Inherent Risks received an email from the claims department of a travel insurer in the U.S. based on a recommendation from another travel insurance provider.
The Claims Manager explained that one of their travellers had been struck by a vehicle while crossing the street, and was being held in the waiting room of a hospital in Spain. The hospital was refusing to admit the patient, who required immediate medical treatment, based on them not having an agreement in place with the Third Party Administration (TPA) firm that the insurer used.
This meant the hospital would not accept the Guarantee of Payment (GOP) being sent, and as a result, the patient was suffering unnecessary delays.
Although this particular hospital was out of our network, one of our medical case managers who is based in Spain, was able to intervene. As a result, the patient was immediately admitted for treatment.
Our Medical Assistance team continued to monitor the case, obtain and translate medical reports, and liaise between the treating medical officer, the insurers claims department, and the patients family.
The insurer then requested that we obtain the medical bill on their behalf, provide cost containment services, and facilitate payment for the final bill.
During the tenure of this case, our partnerships team also conducted due diligence on this hospital, and successfully added them to our global medical network, ensuring that any future cases at this particular hospital will not experience any unnecessary delays.